Presentation
Work up for cough and breath shortness.
Patient Data
There is a large, well-defined pleural-based solid mass in the posterior aspect of the right hemithorax with mass effect on the right main bronchus and bronchus intermedius, accompanied by mild ipsilateral pleural effusion. No adjacent bony destruction or vascular encasement.
Case Discussion
The patient underwent right hemithorax mass resection.
Pathology:
The sections reveal proliferated atypical cells having round to oval, and elongated hyperchromic nuclei arranged loosely with the myxoid pattern. Scattered small lymphoid cells are present free throughout the lesion. IHC stain is positive for Vimentin and CD3 and negative for TDT, CD34, CD99, Ckit, S100, LCA, and Calretinin in tumor cells.
Diagnosis: Malignant solitary fibrous tumor, pleural involvement.
Solitary fibrous tumor is a rare neoplasm of mesenchymal origin and ranges from an indolent tumor to more aggressive masses. Usually presents in the 6th to 7th decades. In ~80% of cases, they arise from visceral pleura, and about 30% of solitary fibrous tumors of the pleura are malignant.
Main differential diagnoses include :
- localized mesothelioma
- solitary pleural metastasis
- pleural lymphoma
- peripheral lung cancer
- intercostal nerve neurilemoma (schwannoma)